title: Advanced life support in obstetrics (ALSO) and post-partum hemorrhage: a prospective intervention study in Tanzania.
abstract: OBJECTIVE
  To evaluate the impact of Advanced Life Support in Obstetrics (ALSO) training on staff performance and the incidences of post-partum hemorrhage (PPH) at a regional hospital in Tanzania.
  
  
  METHODS
  Prospective intervention study.
  
  
  METHODS
  A regional, referral hospital.
  
  
  METHODS
  A total of 510 women delivered before and 505 after the intervention.
  
  
  METHODS
  All high- and mid-level providers involved in childbirth at the hospital attended a two-day ALSO provider course. Staff management was observed and post-partum bleeding assessed at all vaginal deliveries for seven weeks before and seven weeks after the training.
  
  
  METHODS
  PPH (blood loss ≥500ml), severe PPH (blood loss ≥1000ml) and staff performance to prevent, detect and manage PPH.
  
  
  RESULTS
  The incidence of PPH was significantly reduced from 32.9 to 18.2%[RR 0.55 (95%CI: 0.44-0.69)], severe PPH from 9.2 to 4.3%[RR 0.47 (95%CI: 0.29-0.77)]. The active management of the third stage of labor was also significantly improved. There was a significant decrease in episiotomies. By visual estimation, staff identified one in 25 of the PPH cases before the ALSO training and one in five after the training. A significantly higher proportion of women with PPH had continuous uterine massage, oxytocin infusion and bimanual compression of the uterus after the training.
  
  
  CONCLUSIONS
  A two-day ALSO training course can significantly improve staff performance and reduce the incidence of PPH, at least as evaluated by short-term effects.
authors.affiliation: Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Denmark. bjarkebjarke@yahoo.dk
authors.forename: Bjarke Lund
authors.initials: BL
authors.lastname: Sorensen
authors.forename: Vibeke
authors.initials: V
authors.lastname: Rasch
authors.forename: Siriel
authors.initials: S
authors.lastname: Massawe
authors.forename: Juma
authors.initials: J
authors.lastname: Nyakina
authors.forename: Peter
authors.initials: P
authors.lastname: Elsass
authors.forename: Birgitte Bruun
authors.initials: BB
authors.lastname: Nielsen
mesh_terms: D000293:Adolescent; D000328:Adult; D016887:Cardiopulmonary Resuscitation; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007318:Inservice Training; D007743:Labor, Obstetric; D008020:Life Support Care / Q000379:methods*; D008405:Massage; D008505:Medical Staff, Hospital / Q000193:education*; D009741:Nursing Staff, Hospital / Q000193:education*; D010121:Oxytocin / Q000008:administration & dosage; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D013636:Tanzania / Q000453:epidemiology; D014599:Uterus
chemical_list: D010121:Oxytocin